Independent Physical Therapy of Georgia, LLC
Organization Active NPI Physical Therapy Clinic/Center · Dunwoody, GA
NPI 1376956003 · NPPES record last updated Feb 21, 2019
Key facts
- NPI
- 1376956003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
- Practice address
- 5500 Chamblee Dunwoody Rd Ste 5B
Dunwoody, GA 30338-4162 - Phone
- (770) 396-3003
- Fax
- (770) 396-3868
- NPI assigned
- Jun 10, 2014
- Organization subpart
- No
Authorized official
- Name
- Kevin Johanneson
- Title
- VP Revenue Cycle
- Phone
- (423) 238-7217
Corporate family (same tax ID) 24
Practitioners 4
-
Dylan Dagenback, PT, DPT
-
Jessica Grace Pybus, LPTA
-
Stephen Paden Wallace, PT, DPT
National Provider Directory
- Tax ID family
- Independent Physical TH
Locations
5500 Chamblee Dunwoody Rd
Ste 5E
Dunwoody, GA 30338
Phone (678) 256-3920
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Yes | ||
| Rehabilitation Clinic/Center | 261QR0400X |
Addresses
Primary practice location
5500 Chamblee Dunwoody Rd Ste 5B
Dunwoody, GA 30338-4162
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217
Other providers in Dunwoody, GA
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- Ryan Alexander Hunter
- Jessica Hutchens
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- Tara Ingold
- Chantelle Latrese Ingram
- Daisuke Inoue
- Caroline Inskip
- Integrative Health and Wellness
All providers in Dunwoody, GA · Physical Therapy Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.